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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ9373269, ADJ9373270
Regular
Dec 12, 2017

SOCORRO SALAZAR vs. MV TRANSPORTATION, ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration, upholding the WCJ's finding that the applicant failed to prove her injury was presumptively compensable under Labor Code section 5402. The Board clarified that the 90-day presumption period begins when an employee files a claim form, not when the employer receives notice of injury. The Board affirmed that a claim form, not an Application for Adjudication of Claim, is the legally mandated method for initiating a workers' compensation claim. Therefore, the applicant did not meet her burden of proof for presumptive compensability.

WCABPetition for ReconsiderationLabor Code section 5402presumption of compensabilityclaim formdenial of liabilityApplication for Adjudication of Claimrebuttable presumptionfraudulent attemptsstatutory references
References
Case No. ADJ7949972
Regular
Nov 07, 2013

DANIEL BIGELOW vs. CITY OF PASO ROBLES

This Workers' Compensation Appeals Board decision reverses a prior ruling and finds applicant's colon cancer industrially caused. The employer failed to rebut the Labor Code section 3212.1 presumption of industrial causation for peace officers exposed to carcinogens. The Appeals Board determined the defendant's medical expert did not sufficiently prove the cancer was "not reasonably linked" to the applicant's workplace exposure. Therefore, the presumption stands, and the case is returned for further proceedings.

Labor Code section 3212.1cancer presumptionpeace officeractive law enforcementindustrial injurycolon cancercarcinogen exposurerebuttable presumptionprimary site of cancerlatency period
References
Case No. ADJ10002681
Regular
Sep 07, 2018

ALLISON WIGGINS vs. KERN VALLEY STATE PRISON, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration to address the applicant's claim of industrial heart injury, which was initially denied by the administrative law judge despite a finding of industrial hypertension. The Board found that the applicant, a correctional officer, is entitled to a rebuttable presumption of industrial causation for heart trouble under Labor Code § 3212.2. Crucially, the Court determined that the record needs further development to clarify industrial contribution to the applicant's valvular insufficiency, considering the absence of an anti-attribution clause in § 3212.2 which differs from other related statutes. Therefore, the case is returned to the trial level for further development of evidence and a decision on rebuttal of the presumption.

Labor Code section 3212.2heart trouble presumptioncorrectional officerbicuspid aortic valvevalvular diseaseindustrial injurypermanent disabilitycumulative periodrebuttal of presumptionagreed medical evaluator
References
Case No. ADJ9312112
Regular
Apr 17, 2017

CUONG PHAN vs. CITY OF SANTA CLARA

In this case, the Workers' Compensation Appeals Board denied the defendant City of Santa Clara's petition for reconsideration. The Board upheld a prior finding that applicant Cuong Phan sustained industrial injuries to his lower back, resulting in 29% permanent disability. The key issue was the application of the "duty belt presumption" under Labor Code section 3213.2, which presumes lower back impairments in long-term peace officers required to wear duty belts arise from employment. The Board found the presumption applicable and not rebutted, deeming it a legislative intent to protect officers with these specific conditions.

Duty belt presumptionLabor Code section 3213.2police officerlower back impairmentpeace officerpermanent disabilityjoint findings and awardpetition for reconsiderationBenson apportionmentLabor Code section 4663(e)
References
Case No. ADJ8706052 ADJ10117581
Regular
Sep 19, 2018

ROMALDO TRUJILLO QUINTERO vs. CHAMBERLAINS FARMS, STAR INSURANCE COMPANY, administered by MEADOWBROOK INSURANCE GROUP

The Workers' Compensation Appeals Board granted reconsideration, rescinding the prior Findings and Order regarding cumulative trauma injury. The Board found the applicant's cumulative trauma claim presumed compensable due to the employer's failure to deny it within the statutory 90-day period. This presumption could not be rebutted by evidence not obtainable with reasonable diligence within that timeframe, and the WCJ's basis for rebuttal was deemed inadequate. The matter was returned to the trial level for further proceedings consistent with this opinion.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFindings and Orderpermanent disabilityindustrial injurycumulative traumaadministrative law judgeQualified Medical Evaluatorsorthopedic injury
References
Case No. ADJ10685699
Regular
Jan 22, 2019

DAVID CISAR vs. ORANGE COUNTY FIRE AUTHORITY

This case involved a fire captain who claimed industrial injury for melanoma and lymphoma, with the latter being the focus of the appeal. While the applicant was presumed compensable for leukemia/lymphoma under Labor Code section 3212.1 due to benzene exposure, the defendant successfully rebutted this presumption. The rebuttal was based on an independent medical evaluator's opinion that the short period between negative diagnostic tests and the cancer's manifestation made an industrial link unreasonable. The Board adopted this reasoning, denying the petition for reconsideration.

Workers' Compensation Appeals BoardOrange County Fire AuthorityPermissibly Self-InsuredCorvel CorporationFire CaptainCumulative InjuryMelanomaLymphomaChronic Lymphocytic LeukemiaSmall Lymphocytic Lymphoma
References
Case No. ADJ10549266
Regular
Jan 18, 2018

VICTOR QUINTANILLA (DEC'D), HEIDI QUINTANILLA vs. PRONTO EXPRESS & SERVICES, INC., ISHMAEL PATEL, UNINSURED EMPLOYERS BENEFITS TRUST FUND

In this workers' compensation death benefit claim, the defendant employer sought reconsideration of a finding that the decedent sustained injury arising out of and in the course of employment. The appeals board affirmed the decision, primarily because the employer failed to timely deny the claim within the 90-day statutory period. This untimely denial created a rebuttable presumption of compensability under Labor Code section 5402(b). The defendant's argument regarding the "going and coming" rule became moot as they failed to raise any objection to the timeliness of the denial in their petition. Therefore, the original findings and award of death benefits were affirmed.

Workers Compensation Appeals BoardReconsiderationInjury Arising Out Of and In the Course Of Employment (AOE/COE)Going and Coming RuleLabor Code Section 5402(b)Presumption of CompensabilityUninsured Employers Benefits Trust FundTimely DenialRebuttal of PresumptionReasonable Diligence
References
Case No. ADJ885979 (LBO 0310057)
Regular
Feb 20, 2014

WALTER CERVANTES vs. UNITED AIRLINES INFLIGHT SERVICES, GALLAGHER BASSETT SERVICES, INC.

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal to address the WCJ's exclusion of the Labor Code section 5402 presumption of compensability. The Board held that this presumption can be raised for the first time at trial, even if not listed on the pre-trial conference statement. The case is returned to the trial level for the WCJ to consider the presumption, ensuring the defendant has an opportunity to present evidence and witnesses on the issue. This decision aligns with precedent allowing presumptions to be raised at trial under certain circumstances.

Petition for RemovalPresumption of CompensabilityLabor Code Section 5402Mandatory Settlement ConferencePretrial Conference StatementWorkers' Compensation Appeals BoardWCJOrder Granting PetitionDecision After RemovalDue Process
References
Case No. ADJ8109410
Regular
Apr 03, 2015

KRISTINA BROOKS vs. COUNTY OF TULARE

The Workers' Compensation Appeals Board reversed the Administrative Law Judge's decision, finding that the applicant's hiatal hernia and GERD were not industrial injuries. The Board determined that the Labor Code section 3212 presumption for hernias in law enforcement officers was rebutted by medical evidence. Specifically, the Board found that the applicant's hiatal hernia was primarily caused by complications from a prior non-industrial bariatric surgery, not her employment. Therefore, the Board rescinded the award for medical treatment and temporary/permanent disability.

Labor Code section 3212presumptionrebuttalhiatal herniaGERDQualified Medical EvaluatorIra FishmanM.D.deposition testimonybariatric surgery
References
Case No. ADJ10569473
Regular
Sep 12, 2017

EDWIN RAQUEDAN (deceased), IMELDA RAQUEDAN vs. VIOLA, INC.; EVEREST NATIONAL INSURANCE COMPANY

This case concerns whether the presumption of compensability under Labor Code section 5402 applies to a deceased accountant's fatal car accident claim. The defendant employer contests the finding that this presumption was triggered because no DWC-1 claim form was ever filed by the applicant. The Appeals Board granted reconsideration, rescinded the trial judge's order, and returned the matter for further proceedings. The Board noted that under *Honeywell*, the 90-day presumption period runs only from the filing of a claim form, not from the employer's general knowledge of an injury.

Labor Code section 5402presumption of compensabilityPetition for ReconsiderationFindings and OrderIndustrial causationMotor vehicle accidentClaim formRebuttable presumptionHoneywell v. Workers' Compensation Appeals BoardOpinion on Decision
References
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